Introduction

We are four Karen women who live in Wyndham and Hobson’s Bay. We felt that service providers needed to understand the Karen community better, so they could work more effectively and respectfully with our community.

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The Karen-Burmese live in mountainous jungle regions of Myanmar (southern and eastern), and Thailand.

Myanmar is located in Southeast Asia:– Formally known as Burma– Developing and largely rural– Bordered by China, Tibet, Laos, Thailand, Bangladesh and India

Ethnic Groups Major ethnic group: Burmese

Largest indigenous population: Karen

Other indigenous races include:– Shans– Chins– Mon– Rakhine– Katchin

Ethnic tension between Burman majority and minority ethnic groups

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Background

Grow rice in paddy fields

Traditionally Karen men wear a sarong and a sleeveless shirt, unmarried Karen women wear a long white dress, and married Karen women wear a sarong and sleeveless shirt. The design of male shirts and sarongs are different to female shirts and sarongs, and males and females tie their sarongs in different ways.

Different Karen sub-groups have different designs for their clothing, but all follow the same basic pattern. Different sub-groups also have different designs for their shoulder bags.

Karen people have been in state of civil war for much of the past 60 years.

The Karen people live in hilly eastern areas of Burma are mostly internally displaced and currently live as refugees in camps on the Thai-Burma border. This is due to the country’s internal armed conflicts and fighting between troops loyal to the Burmese military junta and those to the armed Karen freedom fighters, who are also known as the Karen National Liberation Army under the political leadership of the Karen Nation Union.

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Before leaving Burma, the Karen people experienced many human rights violations in their homeland.

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Many Karen people have escaped to Thailand and lived in one of nine refugee camps.

Many people have lived in the refugee camps for twenty years or more. Many children were born in the camps and that is the only life they have known.

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Life in the refugee camps is very hard.

The conditions are very basic.

There is only basic education primary level education. Refugees are not able to access any higher education.

The refugees are not allowed out of the refugee camps and cannot work.

However, refugees serve on camp committees, which are the administrative and management bodies of the camps. They also work within the camp as teachers, nurses, etc.

Causes of Karen Refugees’ Health Concerns

Lack of resources and services

Malaria screening and treatment is not readily available

Malnutrition and vitamin deficiencies

Forced displacement and extensive traumatic experiences

Complete lack of oral and dental health care

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In Burma the largest indigenous population are Karen. Other indigenous races include Shans, Chins, Mon, Rakhine and Ktchi. There are always tensions between Burmese majority and other minority ethnic groups.

Each cultural group is distinct from the Burmese ethnic group and most do not want to be called “Burmese.”

Do not refer to the Karen people as Burmese. Ethnically, they are a completely different group and many will not even speak Burmese. The Karen were exiled from the country of Burma. They were driven out by the Burmese. So many Karen people will not identify with the Burmese in a very positive way.

It is much better to refer to people by their ethnic group (Karen, Chin, Kachin, Shan, Karenni) rather than call them Burmese.

When referring to multiple ethnic groups, use “refugees from Burma” rather than “Burmese refugees”.

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Karen people follow three religions: Christianity, Buddhism or animism. Some Christians and Buddhists retain elements of animism in their beliefs.

The biggest Christian denominations are Catholic, Baptist and Seventh Day Adventist.

Christians are persecuted by the Burmese authorities.

In Australia, most Karen are Christian but there are also Buddhist Karen.

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When they encounter a problem, community members will often seek help from a trusted religious or political leader, friend or family member.

Privacy and discretion is of utmost concern.

Where appropriate, leaders or friends will refer to services, encourage family meetings, counsel a person one-on-one, etc.

Polite and respectful culture, especially to those people seen to be in authority or knowledgeable, like doctors, teachers, etc. This may seem to be acquiescence, passivity and fear to non-Karen people.

Indirect communication

Teachers are highly respected (thara, tharamu)

In Karen culture, older people are considered seniors. Age is considered the most important, no matter the ranks or educational backgrounds. The oldest person or older people are expected to be treated with care, kindness, and respect.

Fierce fighters, policy of no surrender

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Self-promotion is considered shameful – will downplay their skills

Taught not to ask questions in school and by elders – it is considered rude and disrespectful

“The bigger crime/issue, make it smaller; the smaller crime/issue, make it disappear.”

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Eye contact

Direct eye contact is considered rude

You must show respect to elder or authority figure by not making eye contact –averting your eyes is a sign of respect not disrespect or hiding something

However, services often interpret this as the Karen person hiding something or being disrespectful.

This can have bad consequences, especially with police.

Being direct is considered culturally rude

You need to be sensitive to this and understand the meaning of lack of eye contact

Direct eye contact is rude, looking away or lowering your head is more respectful

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Using given names

Karen people don’t usually refer to others by their first name.

Use of the person’s first name is seen as rude.

Instead they say ‘sister’, ‘uncle’, ‘grandma’, etc. If you refer to the Karen person only by their first name, they will feel you are being rude.

This is a barrier to building a relationship.

Use ‘sister’, ‘brother’, ‘grandfather’, ‘auntie’, etc instead – either in English or Karen.

Some key terms in Karen are: Daymu – younger sister, No da – older sister

Karen culture is very welcoming to guests.

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Calling to someone with your index finger

Using finger to indicate ‘come here’ can be very rude.

This is not just in Karen culture but some other cultures too.

This is very bad for building a relationship with Karen people

Demonstrate the wrong way and the right way

Emotions

Sometimes Karen people might smile or even laugh at what seems like a strange time.

This can be a sign of shame, fear, embarrassment, nervousness, shyness or trying to hide their real emotion.

This behaviour can be misinterpreted and the non-Karen person could respond badly or judge the Karen person.

This is a big problem with police or after a car accident.

You need to be sensitive to the true meaning of the smiling and what emotions the Karen person is really feeling.

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Women asking permission from husbands

When a woman asks permission from her husband to do something, this is a sign of a good and open relationship.

In a good Karen relationship, this goes both ways — husbands ask their wife for permission too.

Asking permission and ‘obeying’ is not a sign of the man controlling the woman or the woman being in fear of the man. Rather, it is the way husbands and wives show care and respect to each other.

Karen husbands and wives should share their ideas and concerns with each other.

If there is no discussion between husband and wife (no asking permission from each other) this could mean there’s something wrong in the family.

Sometimes there might be control in the family but you need to look more closely than this to work out if that is happening.

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Divorce

Divorce is very problematic in Karen culture.

Before you suggest to a Karen woman that she should divorce her husband (due to family violence or other concerns), you need to understand the importance of family to refugees and the role of family in Karen culture.

For people who have fled their country as refugees, the family in Melbourne is always very close. They share their burden with each other and help each other.

Many of us have lost family members or are separated from our families for many years.

Family is what makes us feel more safe and secure. Without family we would be completed socially isolated and lonely.

Without our family we couldn’t survive, family is critical for our wellbeing.

Divorce is a difficult concept in our culture. It carries a lot of stigma (judgement) – if someone gets divorced they will be judged and seen as having a ‘bad history’ that will follow them forever.

Divorce also has a big impact on children – they have less opportunities because of the stigma.

If you are concerned about a woman’s wellbeing, instead of divorce you could suggest temporary separation where the husband or wife stays with a family member for a period.

The most important thing is to give a Karen woman choices and the power to make a decision that is best for her, not to push the option you think is best.

Sexual health and sensitive topics

This can be sensitive and difficult to discuss.

It is important to explain why you want to talk about this and why you need to ask these questions.

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Do not be upset if someone answers “no” when offered something, or when an affirmative answer might seem more appropriate. Saying “no” is often a way to be modest.

For example, someone might be really hungry but refuse food – you should ask a few times or leave some food

Sometimes people might say ‘yes’ but not mean it; this is often about feeling obligated or unable to say no.

You need to listen deeply to understand the true meaning or feelings.

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Woman should not wash her hair after birth

Don’t touch rain water or soap

Keeping warm temperature, e.g. hot water bottle or staying close to heater

It is thought that the heat helps speed up recovery

Lack of familiarity with Australian foods and how to prepare them Lack of access to traditional foods Low English print literacy resulting in difficulty reading labels and written

guidelines/dietary advice Food knowledge – including water safety – for example knowing that tap water is safe

to drink, safe food storage and food handling Poverty Shift work and irregular or individual household eating routines.

Children’s eating Important to introduce children to Australian food slowly and be supportive of eating

Asian food Need to provide information to parents about what to give the kids

Maternal depression, resulting in failure to thrive in infants, may be related to mother's sense of bad outcomes/future because of her inability to follow post partum rest and dietary practices in this country.

Traditionally children are not given a formal name until the child goes to school. In Australia, families are giving formal names at birth that do not change (due to birth certificate requirements) and often combine western and traditional Asian names.

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Leaders try to encourage by saying “at least you’re not in the camp, in the IDP area”, etc.

“No one can take care of your problems when it comes to your feelings. Deal with it on your own.”

Lack of familiarity with mental health services and how they can help

Very big stigma around mental health issues – this is a very new issue

Mental health services need to do outreach and community engagement with Karen community to break down barriers and educate them – otherwise they will not seek help

Also need to explain what people can expect when they access this help – being asked many questions with no action seems very strange

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Karen has 3 main dialects: S’gaw, East Pwo and West Pwo. Each are mutually unintelligible.

S’gaw is the most common and is taught in the refugee camps Pwo may also speak S’gaw Burmese might sometimes be the common language between a S’gaw and Pwo

speaker While a Karen client may be comfortable speaking Burmese with a Karen interpreter,

they may be very uncomfortable with an interpreter who is ethnically Burmese.

Support person Community members do not always feel comfortable with the interpreter. Community members may also try to avoid ‘being a burden’ to interpreters by not

asking questions ‘Ana’ in Burmese – feeling sorry and guilty, not wanting to be a burden and waste the

interpreter’s time. The presence of a trusted friend or leader often helps community members feel more

comfortable and work more effectively with the service provider.

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Challenges for young people when they settle in Australia

After high school or uni they lost their way (they don’t know what to continue to do)

Focus to become nurse or teacher

After degree they can’t find a job that is suitable for them

Focus to get a jobs (any jobs) if they don’t want to go for further study (end up with working at the meat factory)

At school, students are afraid to ask questions to the teacher (because they worry that when they ask questions it might affect other students in the class)

Drop out of school

Adults

Language problems (how to pay a bills, go to hospital and other community)

Homesick (stay home, afraid to meet new friends/people)

If a little thing happened they don’t ask help from others but if something that they can’t face it anymore then they let them out to let other people know.

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Exploitation in the workplace, by real estate agents, salespeople, etc

Difference in opinions, beliefs, values or goals

Change in family circumstances e.g. new baby, divorce/separation, blending families

Stress, alcohol or drug use

The onset of mental health problems

Bullying and harassment

Lack of trust/respect in a relationship

Surviving on low income

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Paperwork – stress and lack of access

Important not to rely only on letters or paperwork – also verbal communication (phone call)

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Realistic expectations that life in the Australia will be hard

Motivations to resettle: children’s education, safety

Grateful, eager to work, willing to sacrifice to help community members

Strong relationships with churches: offer support, opportunities to socialise, networking, community organising

Karen are trusting partners, and very willing to work with you

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Friendly greeting

Quiet, soft voice and reassuring smiles

Ask about their religion, culture

Explain that what you are doing can benefit the family and that your place is not to judge

Explain confidentiality!

Offer encouragement by complimenting their willingness to learn

Do not approach issues too directly. You may have to re-ask questions in a different way

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Be mindful of potential language barriers. Think about the language used (written, verbal and non-verbal) when communicating

with Karen people. Do not continually ask a person to repeat themselves if it is difficult to understand

them, especially in front of a large group. Speak clearly and as loud as necessary but do not shout. Wherever possible, attend functions in the community that you are invited to –

demonstrates care and support Be aware and cautious of dynamics between families and the community Always be open, honest and respectful Do not refer to the Karen as Burmese Be conscious of the culture of respect and politeness

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